Psoriasis

Eczema presents itself with dry, itching skin. The skin will likely be red and cracked as well. It may look like a bumpy rash.

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About

Psoriasis

Psoriasis is an autoimmune disease that causes raised, red, scaly patches to appear on the skin. Psoriasis is a chronic, long-lasting disease. Psoriasis is not contagious.

There are five types of psoriasis. The type of psoriasis you have may help you determine the best treatment for you. The types are:

Plaque psoriasis— is the most common form of the disease and appears as raised, red patches covered with a silvery white buildup of dead skin cells, which usually appear on the scalp, knees, elbows and lower back.

Guttate psoriasis— is a form of psoriasis that appears as small, dot-like lesions, often starting in childhood or young adulthood. This type of psoriasis can be triggered by a strep infection. Guttate is the second-most common type of psoriasis and affects about 10% of psoriasis sufferers.

Inverse psoriasis— appears as very red lesions in body folds, typically behind the knee, under the arm or in the groin, and it may appear smooth and shiny. It often accompanies another type of psoriasis simulatenously.

Pustular psoriasis— is accompanied by white pustules or blisters surrounded by red skin. The pus contains white blood cells, but it is not an infection, nor is it contagious. It most commonly occurs on the hands or feet.

Erythrodermic psoriasis—is a severe form of psoriasis that leads to widespread, fiery redness over most of the body. It can cause severe itching and pain. Skin can come off in this type of psoriasis. It is rare, occurring only in 3 percent of psoriasis sufferers. It generally appears on people who have unstable plaque psoriasis.

Causes

Psoriasis is believed to be hereditary. It is believed that at least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis. However, only 2 percent to 3 percent of the population develops the disease. It is believed that both the predisposition to psoriasis plus becoming exposed to specific external factors known as "triggers" causes the disease to appear.

Psoriasis triggers are not universal. What may cause one person's psoriasis to become active, may not affect another. Known psoriasis triggers include:

Risk Factors

People who get psoriasis usually have one or more person in their family who has psoriasis. Not everyone who has a family member with psoriasis will get psoriasis. But psoriasis is common. In the United States, about 7.5 million people have psoriasis. Most people, about 80%, have plaque psoriasis.

Psoriasis can begin at any age. Most people get psoriasis between 15 and 30 years of age. By age 40, most people who will get psoriasis, about 75%, have psoriasis. Another common time for psoriasis to begin is between 50 and 60 years of age. Whites get psoriasis more often than other races.

Diagnosis

To diagnose psoriasis, a dermatologist:

Perform an exam of a patient’s skin, nails, and scalp for signs of psoriasis.

Discuss family history of psoriasis.

Discuss patient lifestyle, such as whether a patient has been under a lot of stress, had a recent illness, or just started taking a medicine.

Sometimes a dermatologist also removes a bit of skin and view it under a microscope to confirm the diagnosis.

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Treatment

Treatment

Treating psoriasis has benefits. Treatment can reduce signs and symptoms of psoriasis, which usually makes a person feel better. With treatment, some people see their skin completely clear. Treatment can even improve a person's quality of life.

Work with your doctor to find a treatment—or treatments—that reduce or eliminate your symptoms. What works for one person with psoriasis might not work for another. There are multiple options available for treatment which include:

Biologics— are prescription drugs used for moderate to severe that has not responded to other treatments. They are given by injection or intravenous (IV) infusion. There are risks and side effects associated with the use of biologics which will need to be discussed with your dermatologist.

Systemics— are either oral or injectable prescription drugs that work throughout the body. They are usually used for individuals with moderate to severe psoriasis and psoriatic arthritis. Systemic medications are also used in those who are not responsive or are unable to take topical medications or UV light therapy.

Ultraviolet B (UVB) Phototherapy— also referred to as light therapy, involves consistent exposure of the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a doctor's office or psoriasis clinic or at home with phototherapy unit.

Excimer Laser Therapy— was recently approved by the Food and Drug Administration (FDA) for treating chronic, localized psoriasis plaqus. It emits a high-intensity beam of ultraviolet light B (UVB). The excimer laser can target select areas of the skin affected by mild to moderate psoriasis, and research indicates it is a particularly effective treatment for scalp psoriasis.

Pulsed dye laser— is approved for treating chronic, localized plaques. Using a dye and different wavelength of light than the excimer laser or other UVB-based treatments, pulsed dye lasers destroy the tiny blood vessels that contribute to the formation of psoriasis lesions.

Oral Treatments— improve symptoms of psoriasis by inhibiting specific molecules associated with inflammation. These medications selectively target molecules inside immune cells. By adjusting the complicated processes of inflammation within the cell, these treatments correct the overactive immune response that causes inflammation in people with psoriasis and psoriatic arthritis, leading to improvement in redness and scaliness as well as joint tenderness and swelling.

Topicals— are applied to the skin and are usually the first treatment to try when diagnosed with psoriasis. Topicals can be purchased over the counter or by prescription and include substances such as corticosteroids, salicylic acid, coal tar, aloe vera, jojoba, zinc pyrithione and capsaicin.

Complementary and Alternative — are often sought by patients with chronic conditions because they can help with preventative care and pain management. Some of these include diet and nutrition, herbal remedies, mind and body therapies, alternative therapies, exercise, yoga, and Thai Chi. Much of the evidence supporting complementary and alternative therapies for psoriasis and psoriatic arthritis is anecdotal. Increasingly, researchers have studied complementary and alternative therapies particularly in looking at drug interactions, dietary outcomes and safety. Most complementary and alternative therapies are safe. However, some can interfere with your treatments prescribed by your doctor. Always talk to your doctor or consult with a licensed health care professional before adding any complementary and alternative treatments to your treatment plan for psoriasis and psoriatic arthritis.

Prevention

Living with psoriasis has unique challenges. The good news is health care providers are becoming more aware of the impact psoriasis can have on a person's quality of life. The best way to prevent flare ups is to avoid known triggers, such as stress or foods. You should also work with your dermatologist to manage the symptoms.

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FAQs

What Is Psoriasis?

Psoriasis is a skin disease that causes scaling and inflammation (pain, swelling, heat, and redness). Skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.

Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can show up other places such as fingernails, toenails, genitals, and inside the mouth.

Who Gets Psoriasis?

Anyone can get psoriasis, but it occurs more often in adults. In many cases, there is a family history of psoriasis. Certain genes have been linked to the disease. Men and women get psoriasis at about the same rate.

What Causes Psoriasis?

Psoriasis begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells. People with psoriasis may notice that sometimes the skin gets better and sometimes it gets worse. Things that can cause the skin to get worse include:

Infections.

Stress.

Changes in weather that dry the skin.

Certain medicines.

How Is Psoriasis Diagnosed?

Psoriasis can be hard to diagnose because it can look like other skin diseases. The doctor might need to look at a small skin sample under a microscope.

How Is Psoriasis Treated?

Treatment depends on:

How serious the disease is.

The size of the psoriasis patches.

The type of psoriasis.

How the patient reacts to certain treatments.

All treatments don't work the same for everyone. Doctors may switch treatments if one doesn't work, if there is a bad reaction, or if the treatment stops working.

Topical Treatment: Treatments applied right on the skin (creams, ointments) may help. These treatments can:

Help reduce inflammation and skin cell turnover

Suppress the immune system

Help the skin peel and unclog pores

Soothe the skin.

Light Therapy:Natural ultraviolet light from the sun and artificial ultraviolet light are used to treat psoriasis. One treatment, called PUVA, uses a combination of a drug that makes skin more sensitive to light and ultraviolet A light.

Systemic Treatment: If the psoriasis is severe, doctors might prescribe drugs or give medicine through a shot. This is called systemic treatment. Antibiotics are not used to treat psoriasis unless bacteria make the psoriasis worse.

Combination Therapy: When you combine topical (put on the skin), light, and systemic treatments, you can often use lower doses of each. Combination therapy can also lead to better results.

What Are Some Promising Areas of Psoriasis Research?

Doctors are learning more about psoriasis by studying:

Genes

New treatments that help skin not react to the immune system

The association of psoriasis with other conditions such as obesity, high blood pressure, and diabetes.